Business Plan
About A business plan is a formal statement of a set of business goals, the reasons they are believed attainable, and the plan for reaching those goals. It may also contain background information about the organization or team as well as how the clinical engineering team will attempt to reach those set goals. When an existing department plan is to assume a major change or when planning a new venture, a 3 year business plan is required, so corporate suite (C_Suite) can look for their annual return in that time frame. Presentation The following format of a clinical engineering business plan depends on these 5 key factors: 1. Department History 2. What direction are we going 3. Where we are today 4. Short/Long term goals 5. How we will obtain these goals 6. 'S'trengths, 'W'eaknesses, 'O'pportunities, and 'T'hreats (SWOT) 7. Needs Analysis 8. This and Next years Proposals 9. Summary Procedure 1. Department History Staffing before 2010 was a full time manager and three full time technicians. The staffing was reduced to two technicians, with one acting as a lead technician and no management oversight. There was very little management functions at first as preparation for an JCAHO/AAAHC in 2010 because the previous manager was able to effectively manage that function. Zero discrepancies were found. Management functions have decreased since 2010 and the shop is unable to meet peer standards. This increase in management time currently takes up a minimum of 80% of the current lead technician’s time to include reports, regular meetings, hazard alerts and recall monitoring and tracking, planning equipment and replacement, educating staff on the safe and effective use of equipment, investigating device failures and near misses, technology assessment to control costs, and ensure hospital/clinic compliance with full accreditation as well as local self-inspection standards. The clinical engineering department has also expanded its responsibilities in handling more high equipment in-house by reducing contracts and an increased high dollar equipment inventory due to hospital expansion, such as MRI, CT, U/S, Sterilization, etc. yet the Biomedical Equipment Repair department staffing has not changed in over three years. This has put a considerable strain ensuring timely completion of PM’s, adequate manpower for repairs, inability to take vacation, inability to attend advanced medical device training or continuing education especially with the constant change in technology, low morale, etc. upon the department. Actual FTE available hours to repair and maintain equipment have decreased while equipment inventory has increased by approximately 500 pieces of equipment from 2010 to present. The following Business Plan is a proposal from the Clinical Engineering Department to re-engineer itself and to provide the information and guidance to help make an effective decision for the facility. 2. Where/What Is Direction Of Clinical Engineering Field? The Clinical Engineering field has been and continues to move in the direction of operating as a business within a business. It is our goal to offer a total service package oriented to meeting our customers’ needs and expanding their expectation by superior customer service. Services provided by maintaining an adequate maintenance staff will ensure the facility is able to accomplish the medical mission and to take care of the military community and its beneficiaries. This goal is accomplished by offering services in the following areas, but not limited to: Expanding from fix/repair to technical service/support management *Technology Management/Assessment *In-service/Education Management *Risk Management/Assessment *Contract Management *Fiscal Management/Cost Containment, Reduction, Avoidance Regulatory Management *JCAHO/AAAHC *Safe Medical Device Act (FDA) *State of Florida 69A-3.012 *Title 21 CFR Subchapters C. Electronic Product Radiation Control (MRI & Ultrasound) J. Radiological Health (Medical Imaging) H. Medical Devices (CT, Fluoro, & Bone Density) *American Hospital Association (AHA) *American National Standards Institute (AAMI) *National Fire Protection Agency (NFPA) *Occupational Standards Health Administration (OSHA) *Health Services Inspection (HIS) *Mammography Quality Standards Act *Underwriters Laboratory (UL) Other Standards Management *Clinical Laboratory Improvement Amendments College of American Pathology *American College of Radiology Hazardous Product Recall *Product Recall Management Equipment Management *Preventive Maintenance *Repairs *User Training *Calibration *Initial/Acceptance Inspections Vendor Management *Manage Outside Contracts Non-Clinical Systems *Uninterrupted Power Supplies *Hazardous Accumulation Point 3. Identify Where We Are Today We currently perform maintenance on following equipment but not limited to: *MRI/CT *Diagnostic Ultrasounds *Mammography *Bone Density Scanner *Defibrillators *Anesthesia *Incubators *IV Pumps *Apnea Recorders *Exam Lamps *EKG Cart *Hypothermia Units *Oxygen Gauges *Respirators Centrifuges *Vital Signs Monitors *Video Endoscopy Equip *BP Instruments *Microscopes *Steris Sterilizers *Pulse Oximeters *Hematology Analyzer *Urine Analyzer In addition to direct repair and maintenance, we perform the following equipment management services: *Health Device/Products Recalls Management System *Ensure Compliance with Regulatory Agencies *Risk Management for Medical Equipment *Support Services Education *Product Evaluation 4. Goal To provide comprehensive equipment maintenance, repairs and management services at a low cost with high customer satisfaction and to expand service on the following equipment types: *Surgical Tables *Radiology Equipment *MRI/CT *Digital Radiology rooms *Mammography *Bone Density Scanner *Anesthesia Incubators *Diagnostic Ultrasounds *Sterilizers 5. How Do We Obtain our Goal? 1. Justification to obtain additional staffing *Reduce outside service *Transition from vendor use to in-house staff based on labor hours *Skill level determination (add 3, 5, and 7 level) *Improved parts inventory by reducing contracts; saving on payments to the contractors 2. Capital Asset Management Program Partnership *Capping Contract - fixed cost by reducing all full service contracts and accept “first look” contracts. 3. Expand level of in-house experience and further reduce cost by *Attending advanced training courses *Attending manufacturer service schools 4. Expand Relationships within Clinic *Administration *Material Management *Nursing *Information System 5. Develop New Biomedical Organization Chart An organizational chart (often called organization chart, org chart, or org name)) is a diagram that shows the structure of an organization and the relationships and relative ranks of its parts and positions/jobs. 6. S.W.O.T. Analysis 1. STRENGTHS *Parts Inventory *Technical Experience *High Customer Approval *Technological Knowledge *Satisfaction *Cost Awareness *Quality Improvements *JCAHO/AAAHC Compliance *Dedication *Good Internal Resources Used *Communication *Lack of Consultant Usage *High Standards *Self Dependent *Reliable *Regulatory Knowledge *Loyal *Safety Knowledge *Stability *Asset Management *Vendor Relations *Positive Work Environment *Good Working Relationships with Other Departments *Rapid Response 2. WEAKNESSES *Lack of advanced training on Imaging and Lab Equipment *Need More Involvement in Helping Clinic Plan for Future *50/50 For Lead Tech Is Non-Existent, Puts More Work On SSgt Orme *Lack of advanced training on Imaging and Lab Equipment 3. OPPORTUNITIES - Internal *X-Ray *Lab *Mammo *CT/MRI *Ultrasound 4. OPPORTUNITIES - External *Clinics · Vet Care Facilities *140+ Public Access Defibrillator program 5. THREATS *3rd Party Service Contracts 7. Needs Analysis Labor hour standards for Clinical Engineering are typically two hours per piece of equipment per technician per year. The typical Clinical Engineering technician will perform maintenance 70% of his/her time based on 2080 hours per year. The other 30% is vacation, sick time off, training, and other in-house administrative duties. This calculates to 1376 available hours spent maintaining equipment per technician per year. Currently, we have approximately 1615 pieces of equipment in inventory plus we maintain uninterruptable power supplies, blood pressure cuffs, electronic thermometers, wall suction units, otoscopes, instrument/medication carts, battery chargers, digital cameras, and flow meters. These are all non-inventory controlled items. This projects out to approximately 500 labor hours per year. Current staffing would show available hours to perform maintenance at 5458 hours, short fall of 1000 hours. An additional 400 hours of labor time would be utilized to perform maintenance on Radiology CT, and Mammo and Ultrasound Equipment (see figures in projected FTE break down in next section). This brings the FTE total to approximately 3.9. Annual Hours =Direct Labor Hours = Schedule=2946 hours Unschedul=2012 hours Non-inventory=500 hours Total Available Hours=5458 hours =Indirect labor Hours = work week / year=2080 hours SLH=360 hours # hours in shop=1720 hours Productivity multiplier=0.8 actual hours worked=1376 hours =# FTEs requirement = FTE=3.966569767 This FTE value aligns with other Clinical Engineering peer departments or bases within the Air Force (see peer figures extracted from AFMLO device inventory search and August 2013 Authorized versus Assignment listing. Those FTE values are in next section). 8. This Years Proposal Staffing An additional FTE to handle basic Radiology/Ultrasound and general Biomedical Equipment would help offset the additional workload that the MERC used to perform and maintain compliance standards. Maintenance Costs We recommend moving toward first look contracts that would be utilized to assist us in moving to perform in-house maintenance on diagnostic Radiology and Ultrasound equipment. This contract type will enable us to cancel or to allow the expiration of all our full-service contracts and have maintenance performed on a first look basis. This would allow us to fund x1 qualified technician as stated in “Staffing” and gradually assume responsibility for the maintenance in-house while acquiring experience related to deployments and instilling customer confidence. This alternative would allow the facility to function in a more self-reliant manner since time and materials is a very high risk on Radiology and Ultrasound equipment and can fluctuate up or down by as much as 30%. The second benefit is that all maintenance costs are then located in one budget and managed between Clinical Engineering. Training Costs: Remain the same. Schools for X-ray and Biomed help reduce contracts. 9. Next Years Proposal Staffing New FTE to absorb workload from increased workload and expansion by imaging specialist into MRI, CT, Ultrasound, and Mammo units. Additional 400 hours, possibly could also handle bone density scanner with maintenance in-house. Maintenance Costs No changes Training Costs School for CT will have to be funded since course already paid for locally to help cancel contracts. 10. Summary The Clinical Engineering Department is a value added multifaceted, multi-talented group. Dedicated to providing a safe environment with high customer service for a very low cost. The main weakness we have is our lack of manpower. An additional FTE would save money and keep us in compliance. Our main strengths are our technical ability, our desire to take on new challenges and to successfully and safely accomplish the mission. This has been evident in our obtaining schooling on MRI and CT and begin providing maintenance on these devices in-house. Only two clinics, Tyndall AFB and Luke AFB, have these similar modalities as well as the number of like devices and are able to be successfully compliant. Cost of maintaining equipment will increase dramatically over the next five years as devices become more sophisticated. Our approach in obtaining training and maintaining these devices in-house will save the facility between $550,000 - $750,000 over the next five years. Our recommendation is to utilize a capping contract to cap maintenance costs and to increase our staffing by providing an additional biomedical repair technician to augment the department in ensuring all clinic equipment is properly maintained and to provide more “hand” to assist with the overall PM’s and maintenance of our high tech/high cost Radiological equipment. The capping puts all maintenance contract costs into one budget while the technician allows for in-house maintenance as well as decreases equipment down time waiting for vendors to arrive on-site. It also provides for an increased utilization of equipment. As the facility’s expert consultants on medical equipment; an additional technician would allow us to offer a well-rounded experienced department capable of supporting this clinic virtually free from outside services. Reference Link Category:General Management